P07-12 Stakeholders perspectives on exercise referral schemes in Germany

Abstract Background There is a growing popularity of exercise referral schemes (ERS) and they are widely implemented in nations such as New Zealand and Sweden. To this point, the German health care system (GHCS) is not utilising a structurally implemented ERS, but a research project is currently conducted to develop and test a German ERS. In the first project phase, the aim was to introduce the topic of ERS to relevant stakeholders of the GHCS and to gather their expert opinions on such a potential ERS. Further, the aim was to familiarise the stakeholders to the project and its collaborative approach in developing and testing an ERS. Methods Semi-structured interviews were conducted with 12 relevant stakeholder of the GHCS. In each case, two researchers conducted the interviews between June to September 2019. Main topics addressed during the interviews were potential target groups for an ERS, their own role within an ERS, PA counselling and dropouts that would be expected. During the interviews, stakeholders were encouraged to sketch their ideas for how to organise an ERS on paper. In the analysis, we digitalised these sketches into flow-chart diagrams. Results The analysis of the interviews showed that the sketches proposed innovative additions and alternative PA promotion strategies within the GHCS. The stakeholders identified barriers within the GHCS such as the rigid costing of treatments and performance measurements. Some reoccurring important core elements for an ERS in Germany were suggested: having a supportive person, implementing PA behaviour impact, utilising existing PA programs and tailoring individual PA counselling. Some stakeholders envisioned an ERS focusing on their perspectives and desired role within the ERS while others outlined ERS that largely excluded them. Conclusions All stakeholders clearly expressed the need for collaboration to develop and test an ERS in Germany. Previous studies have been focused on factors that influence effectiveness, as uptake and adherence. In contrast, these interviews resulted in the identification of concrete barriers and facilitators from the administrative perspective within the GHCS. Different stakeholders show varying degrees of interest in being part of an ERS. This information is highly valuable for the upcoming collaborative process.


Background
Exercise referral schemes (ERS) are embedded in the routine practice of healthcare systems in many countries (e.g. Sweden and New Zealand). In primary healthcare, ERS are recommended to sustainably increase physical activity (PA) levels among patients with noncommunicable diseases (NCD). Yet, the German health care system currently only incorporates interventions that primarily focus on improving functional outcomes but hardly aim at increasing PA levels. This presentation introduces an ongoing research project that aims to develop, implement and evaluate an ERS to promote PA for persons with NCD within the German healthcare system.

Methods
In the first phase of the project, a concept of an ERS was developed using a participatory research approach that involved relevant stakeholders such as physicians, funding agencies, PA providers, and patient representatives. The development process comprised three steps: 1) interviews to gather stakeholders' ideas of an ERS; 2) a literature review to collect evidence on key elements of international ERS; 3) three stakeholder meetings to combine scientific evidence with stakeholders' perspectives (co-creation). Subsequently, the ERS will be implemented, tested and evaluated in a regional pilot project using a pragmatic trial design. Finally, a concept for scaling-up the ERS to the German national level will be developed.

Results
As result of the co-creation process, the following key elements were defined to be part of the ERS: Screening, short counselling and provision of a referral form by a physician; initial assessment, counselling, individual PA recommendations, re-assessment and follow-up by exercise professionals. Additional aspects considered important for the implementation of the ERS were ensuring good communication and feedback between all participating health professionals, as well as an overview of all local physical activity offers and exercise professionals (database). These preliminary findings were combined into a draft of the ERS.

Conclusions
The participatory research approach employed by our project yielded the first draft of an ERS with a specific focus on PA promotion among persons with NCD within the German healthcare system. In the upcoming project stage, this ERS Abstract citation ID: ckac095.112 P07-12 Stakeholders perspectives on exercise referral schemes in Germany Inga Naber 1 , Eriselda Mino 1 , Sarah Klamroth 1 , Anja Weissenfels 1 , Wolfgang Geidl 1 , Peter Gelius 1 , Karim Abu-Omar 1 , Klaus Pfeifer 1 1 Department of Sport Science and Sport -Physical Activity and Health, Friedrich-Alexander University, Erlangen, Germany Corresponding author: inga.naber@fau.de

Background
There is a growing popularity of exercise referral schemes (ERS) and they are widely implemented in nations such as New Zealand and Sweden. To this point, the German health care system (GHCS) is not utilising a structurally implemented ERS, but a research project is currently conducted to develop and test a German ERS. In the first project phase, the aim was to introduce the topic of ERS to relevant stakeholders of the GHCS and to gather their expert opinions on such a potential ERS. Further, the aim was to familiarise the stakeholders to the project and its collaborative approach in developing and testing an ERS. Methods Semi-structured interviews were conducted with 12 relevant stakeholder of the GHCS. In each case, two researchers conducted the interviews between June to September 2019. Main topics addressed during the interviews were potential target groups for an ERS, their own role within an ERS, PA counselling and dropouts that would be expected. During the interviews, stakeholders were encouraged to sketch their ideas for how to organise an ERS on paper. In the analysis, we digitalised these sketches into flow-chart diagrams.

Results
The analysis of the interviews showed that the sketches proposed innovative additions and alternative PA promotion strategies within the GHCS. The stakeholders identified barriers within the GHCS such as the rigid costing of treatments and performance measurements. Some reoccurring important core elements for an ERS in Germany were suggested: having a supportive person, implementing PA behaviour impact, utilising existing PA programs and tailoring individual PA counselling. Some stakeholders envisioned an ERS focusing on their perspectives and desired role within the ERS while others outlined ERS that largely excluded them. Conclusions All stakeholders clearly expressed the need for collaboration to develop and test an ERS in Germany. Previous studies have been focused on factors that influence effectiveness, as uptake and adherence. In contrast, these interviews resulted in the identification of concrete barriers and facilitators from the administrative perspective within the GHCS. Different stakeholders show varying degrees of interest in being part of an ERS. This information is highly valuable for the upcoming collaborative process. Keywords: exercise referral, physical activity promotion, primary healthcare, participatory research approach, physical activity on prescription Abstract citation ID: ckac095.113 P07-13 Barriers and opportunities to improve collaboration between healthcare and physical activity professionals involved in prescribing physical activity for inactive people in the Netherlands Dorine Collard 1 , Kirsten Gutter 1 1 Mulier Institute, Utrecht, The Netherlands Corresponding author: d.collard@mulierinstituut.nl

Background
Healthcare professionals play an important role in motivating inactive people with a chronic disease (e.g. diabetes, cancer, heart disease) for physical activity. They can initiate a discussion about physical activity with the patient and refer to a physical activity (PA)-professional for more detailed action-planning through 'physical activity on prescription'. However, the collaboration between healthcare and PAprofessionals to refer and guide patients to physical activities is in its infancy and can be improved. To enhance this collaboration the aim of our study was to evaluate how the collaboration is shaped and what barriers were experienced.

Methods
We conducted an exploratory study in which quantitative qualitative research methods were used. Two questionnaires were distributed among PA-professionals in the Netherlands (spring and autumn 2021). Questionnaires were returned by respectively 209 and 116 respondents. Questions on how the collaboration was shaped, how the collaboration worked and what barriers were experienced were asked. Besides that, two focus group discussions were held with PA-professionals (n = 8) focussing on barriers and opportunities to improve 'Physical activity prescription'.

Results
More than half of the Dutch PA-professionals indicate that they collaborate with healthcare professionals in primary care (56%) to guide patients to physical activities. Far fewer PAprofessionals collaborate with healthcare professionals in secondary care (22%). Half of the respondents indicate that they experience the collaboration in physical activity prescription as insufficient (47%). Most important barriers are determined, for example healthcare and PA-professionals are unfamiliar with each other; there is uncertainty about roles and tasks of professionals involved; there is a lack of communication; PA-professionals sometimes do not have the skills to guide people with a chronic disease. Finally, a lack of time and budget limits the collaboration between professionals involved in physical activity on prescription.

Conclusions
The collaboration between professionals to refer and guide inactive people with a chronic disease from the healthcare setting to physical activities can be improved by responding to the barriers that are indicated by this study. This study contributes to improving health-enhancing physical activity in an inactive target group and decreasing the prevalence of Physical and social of physical activity Background Evidence suggest that greenspace use can be associated children 's physical, mental, social health, and (Tillmann et al., 2018;Mygind et al., 2019;Mygind et 2021). Greenspace can facilitate a wide range of activities and the availability of greenspace is frequently to increased levels of recreational physical Accordingly, contemporary children's declining use prompts a need to understand the factors that frequency of use.

Methods
Aiming to determine to what extent demographic, mental and social factors predict greenspace use for schoolaged (6-15-year-old) children in Denmark, a national online survey was distributed to parents of 10.000 0-15-year-old children. From a total of 4772 responses a sub-sample of 3171 responses from parents of school-aged children was included in the analysis for this study. The aim was addressed by answering the following research questions: 1) How often do Danish children use greenspaces? 2) What demographic